L4RJ Chapter Membership Application | California Latinas for Reproductive Justice PowerBase

Contact information

First Name

Last Name

Preferred Language

English (United States)

Spanish

Chinese (China)

Tagalog

Korean

Persian (Iran)

Arabic

Khmer (Cambodia)

Navajo, Navaho

Street Address

City

Postal Code

State/Province

Phone Number

Phone Type

Mobile

Landline

Fax

Membership Type

LA Chapter - Student or Part-time Worker

LA Chapter - Full-time Worker

SD Chapter - Student or Part-time Worker

SD Chapter - Full-time Worker

Demographic Information

Pronoun

She

They

Zie

None of the Above

Gender Identity

Agender, nongendered, or neutrois

Cisgender

Gender non-conforming

Non-binary

Trans/Transgender

Are you a parent?

Yes

Current Occupation

Architecture & Engineering

Arts, Design, Entertainment, Sports, & Media

Building/Grounds Cleaning & Maintenance

Business & Financial Operations

Community & Social Service

Computer & Mathematics

Construction & Extraction

Education, Training, & Library

Farming, Fishing, & Forestry

Food Preparation & Service

Healthcare Practitioners & Techs

Healthcare Support

Installation, Maintenance, & Repair

Legal

Life, Physical, & Social Science

Management

Office & Administrative Support

Personal Care & Service

Production

Protective Services

Sales

Transportation & Material Moving

Grassroots Info

Issues Interest

Access to Abortion

Comprehensive Sex Ed

Contraceptives & Family Planning

Economic Justice

Educational Justice

Environmental Justice

Health & Wellness

HIV/STI Prevention

Immigrant Rights

LGBTQ Rights & Queer Liberation

Racial Justice

State Violence & Incarceration

Teen Pregnancy Prevention

Violence Prevention

Youth Sexuality/ Young Parents

Volunteer Interests

Admin/Office

Canvassing

Community organizing

Fundraising

Graphic Design

Media/Communications

Outreach/Tabling

Phone banking

Policy Advocacy

Public Speaking/Presentations

Research

Policy advocacy/Lobbying

L4RJ Membership Application

Tell us in a few sentences why reproductive justice is important to you and your community?

Please let us know what topic areas you are most interested in learning or developing. (Check all that apply)

Community Organizing, Outreach and Education

Communications and Media

Story Collection

Research

Fundraising and Grant Writing

Policy Advocacy

Voter Engagement and Outreach

What do you hope to gain from your membership in Latinas4RJ? What interests you most about becoming a member of Latinas4RJ?

What do you hope to contribute to the leadership chapter? What professional and personal qualities would you like to share in a space like Latinas4RJ?

Please share any skills or experience you bring to the chapter (Ex. Graphic Design, Social Media, Research experience, etc)

Are you involved in any other community organizations or causes? (Please explain briefly)

Do you need childcare, travel, or any type of support or accommodations to attend Latinas4RJ activities? (Please explain below)

Yes

Please explain what type of support or accommodations you need to attend Latinas4RJ activities?

COMMITMENTS: Please review and agree the following commitments in order to submit your membership application.

I can contribute the annual membership dues ($50 for full-time employees, $25 for part-time/student

I can commit to at least two policy advocacy activites per year

I can commit to at least two community engagement activities per year

I commit to attend monthly chapter meetings (usually weekends for up to 3 hours) and additional activity planning meetings

If you have any questions or concerns, please contact michelle@clrj.org or 323-230-3077